新型冠状病毒肺炎死亡患者80例的临床特征分析

Clinical analysis of 80 death cases with coronavirus disease 2019

目的:分析新型冠状病毒肺炎(COVID-19)死亡病例的临床特征和死亡原因,为降低患者病死率提供借鉴。方法:对2020年1月11日至2月11日武汉大学人民医院收治的80例COVID-19死亡患者的临床资料进行回顾性分析。并对患者入院后第1次与死亡前最后一次的白细胞计数、淋巴细胞计数、降钙素原、乳酸、D-二聚体、纤维蛋白降解产物、N末端脑钠肽前体、超敏肌钙蛋白I、乳酸脱氢酶、CD4+T淋巴细胞计数进行比较。统计学分析采用配对t检验或威尔科克森符号秩检验。结果:80例死亡患者的中位年龄为72岁,年龄≥60岁者占78.75%(63/80)。入院时重型患者36例(45.00%),危重型44例(55.00%);58例(72.50%)合并有基础疾病,主要为高血压、糖尿病、冠状动脉粥样硬化性心脏病、慢性阻塞性肺疾病等。患者入院后第1次与死亡前最后一次实验室检查结果比较,白细胞计数升高[8.01(4.86,12.29)×109/L比12.55(8.25,17.66)×109/L],淋巴细胞计数降低[0.70(0.46,0.88)×109/L比0.54(0.39,0.75)×109/L],降钙素原升高[0.20(0.11,0.74)μg/L比1.00(0.20,1.99)μg/L],乳酸水平升高[2.10(1.40,3.10)mmol/L比3.10(2.60,4.10)mmol/L],D-二聚体升高[4.33(0.97,18.98)mg/L比15.29(5.17,53.44)mg/L],纤维蛋白降解产物升高[15.90(3.58,76.60)mg/L比63.14(21.23,110.67)mg/L],N末端脑钠肽前体升高[1078.00(347.35,2996.50)ng/L比3439.50(1576.00,9281.50)ng/L],超敏肌钙蛋白I升高[0.08(0.03,0.17)μg/L比0.33(0.14,2.47)μg/L],乳酸脱氢酶升高[397.00(327.00,523.50)U/L比624.00(481.00,854.00)U/L],CD4+T淋巴细胞计数降低[137.00(104.00,168.00)/μL比97.00(67.00,128.00)/μL];差异均有统计学意义(W=238.00、1053.50、150.00、152.00、192.00、190.00、108.00、57.00、53.00、40.00,均P<0.05)。80例患者均接受了抗病毒治疗和呼吸支持等综合治疗,然而病情迅速恶化,入院后1 d内死亡7例,7 d内死亡66例,主要死亡原因是顽固性低氧血症引起的呼吸衰竭及其不可逆的多器官功能衰竭。结论:合并有慢性基础疾病的老年COVID-19患者的预后较差,在病程早期加以重视并予对症治疗,对改善其预后至关重要。

Objective To analyze the clinical characteristics and causes of death of 80 dead cases with confirmed coronavirus disease 2019(COVID-19).Methods The clinical data of 80 dead patients with COVID-19 who were admitted to Renmin Hospital of Wuhan University from January 11 to February 11,2020 were retrospectively analyzed.The laboratory examination indexes(including white blood cells,lymphocytes,procalcitonin(PCT),lactic acid,D-dimmer,fibrinogen degradation products,N-terminal pro-brain natriuretic peptide(N-proBNP),ultra sensitive-troponin I,lactate dehydrogenase(LDH)and CD4+T lymphocyte)of the patients at the time of admission were compared with the indexes at the last time before death.Statistical analysis was conducted by using paired t test or Wilcoxon′s signed rank test.Results The median age was 72 years old of the 80 patients,and 78.75%(63/80)of them were older than 60 years.Thirty-six cases(45.00%)were severe and 44(55.00%)were critical at admission.Fifty-eight cases(72.50%)had underlying diseases.The common underlying diseases were hypertension,diabetes mellitus,coronary atherosclerotic heart disease,and chronic obstructive pulmonary disease.Comparing the patients′first laboratory tests at admission with those before death,white blood cells increased(8.01(4.86,12.29)×109/L vs 12.55(8.25,17.66)×109/L),lymphocytes decreased(0.70(0.46,0.88)×109/L vs 0.54(0.39,0.75)×109/L),PCT increased(0.20(0.11,0.74)μg/L vs 1.00(0.20,1.99)μg/L),lactic acid increased(2.10(1.40,3.10)mmol/L vs 3.10(2.60,4.10)mmol/L),D-dimmer increased(4.33(0.97,18.98)mg/L vs 15.29(5.17,53.44)mg/L),fibrinogen degradation products increased(15.90(3.58,76.60)mg/L vs 63.14(21.23,110.67)mg/L),N-proBNP increased(1078.00(347.35,2996.50)ng/L vs 3439.50(1576.00,9281.50)ng/L),ultra-sensitive troponin I increased(0.08(0.03,0.17)μg/L vs 0.33(0.14,2.47)μg/L),LDH increased(397.00(327.00,523.50)U/L vs 624.00(481.00,854.00)U/L)and CD4+T lymphocyte decreased(137.00(104.00,168.00)/μL vs 97.00(67.00,128.00)/μL).The differences between the two groups were all statistically significant(W=238.00,1053.50,150.00,152.00,192.00,190.00,108.00,57.00,53.00 and 40.00,respectively,all P<0.05).All patients received antiviral and respiratory-support therapy and the main cause of death was respiratory failure caused by intractable hypoxemia and multiple organ failure.Among them,seven cases died in one day hospitalization,and 66 cases died in seven days hospitalization.Conclusions Elderly patients with a variety of chronic underlying diseases have poor prognosis.It′s essential to pay more attention and deal with the above clinical characteristics at an early stage to improve the outcome of the COVID-19 patients.